A tall, slightly stooping, gaunt figure

Posted on May 21, 2017 by Snow-Leavis

Dr Robert Hutchison died in 1960, seven years before I was born. However, his appearance as depicted in the portrait (above) reminds me of Roald Dahl. One of his closest friends and colleagues described him in this way:

Dr Robert Hutchison, like Roald Dahl, is recalled for his wonderful way with language. One of my favourite quotes – about the profession in which we have shared across centuries – is by Hutchison. I still find it extraordinary that he wrote this in 1897:

Robert Hutchison was born at Carlowrie Castle, Kirkliston, in 1871.

In the early 1990s I lived with Sian in Kirkliston, at Humbie farm cottages. I was then studying Landscape Architecture at the University of Aberdeen and Sian was completing her GP training in Livingston:

In 1893 Robert Hutchison graduated in Medicine and Surgery at the University of Edinburgh. Like me, he was a very young medical student, but unlike me he was far more promising.

Robert Hutchison delivered his first baby in 1894 at the Simpson Memorial Hospital Edinburgh. I was born in this same hospital 70 years later.

1897, aged just 26 years of age Robert Hutchison co-authored: Clinical Methods: A Guide to the Practical Study of Medicine:

This is still used and is now in its 23rd Edition!

Robert’s sister Isobel Wylie Hutchison was quite amazing. She was a poet, polyglot, painter, botanist and Arctic traveller. She could speak Italian, Gaelic, Greek, Hebrew, Danish, Icelandic, Greenlandic and some Inuit. Carlowrie remained a home for her to return to from travels, although the upkeep was hard and the castle did not have electricity until 1951. Isobel died at Carlowrie in 1982, aged 92.

I was delighted to see Dr Robert Hutchison quoted in a recent BMJ response by Dr Amr K H Gohar. This was in response to this BMJ Analysis:

Dr Gohar titled his response: Primum non nocere (first, do no harm). He summarised the potential harms from early detection which he said may include: overdiagnosis and overtreatment, false positive findings, additional invasive procedures, negative psychosocial consequences, and harmful effects on bodily function.

Dr Gohar confirmed his view [that]: “This does not mean that such early detection should be ignored but it means, as this article stresses, that early detection should be balanced. Critical assessment of early detection including early detection technologies and strategies in clinical practice is indispensable to avoid the persisting bias that early detection is only beneficial.”

This returned my thoughts to communications that I have had with Healthcare Improvement Scotland an NHS Board that is primarily guided by the American organisation: the Institute of Healthcare Improvement.

I have in Hole Ousia expressed my concerns about the approach taken to detection by Healthcare Improvement Scotland. My concerns have related to the lack of consideration of harms of “National Improvement” drives and the continued marginalisation of consent.

Robert Hutchison may have died seven years before I was born. But in 1897 he wrote words that I consider to be most prescient:

"From inability to let well alone;

from too much zeal for the new and contempt for what is old;

from putting knowledge before wisdom, 
science before art, 
and cleverness before common sense;

from treating patients as cases;

and from making the cure of the disease more grievous than 
the endurance of the same,

Good Lord, deliver us."

The stories we hear and the stories we tell

Posted on March 16, 2017 by Snow-Leavis

The stories we hear and the stories we tell from omphalos on Vimeo.

Forgive me for worrying about the lack of philosophy and ethics in science and healthcare today.

‘The sky is making a new proposition to the earth’

Posted on February 24, 2017 by Snow-Leavis

This was a kind of experimental film where I combined an old audio track (narrator and choir) with some of John Berger’s words from “Here is where we meet”. I was perhaps trying to follow John Berger’s statement that he “risks to write nonsense these days”

The audio track is from this film by me: Oor auldest relative (made 2 years ago)

The words are by John Berger from “Here is where we meet” (just recently read by Peter)

This was filmed at Stirling castle in the old cemetery and features the Martyrs monuments.

So what might this film be about?
Well I have no religious faith so it is not about that. 
Perhaps it is about learning over time? 
Perhaps it is about the meeting of Philosophy with Science? 
Perhaps it is about wounds and how we react to them? 
Perhaps it is about how poetry can convey briefly what other 
disciplines of thought may struggle with? 
Or perhaps it is about all of these and more? 
Though, rest assured this film does not offer an overall Philosophy!

Were we asleep at the wheel?

Posted on December 15, 2016 by Snow-Leavis

At the beginning of June 2008 I sent an e-mail to Dr Leon Eisenberg, a former child psychiatrist, and a man of philosophy and science:

Dr Eisenberg was then 89 years old and I wanted to convey how important his writings had been to me:
I did not expect a reply:

A year later Leon Eisenberg died.

After his death a memoir was discovered: which Eisenberg had named “Were We Asleep at the Switch?”.

Eisenberg suggested that a switch from ‘mind’ to ‘body’ has taken place in psychiatry as a discipline, which has led to overuse of medication.

He also argued that “monied interests” had been making de facto decisions on behalf of us all about the “science” of things that might affect us.

Eisenberg was worried that the overwhelming impact of economic considerations may have rendered, and might continue to render futile, the professional contributions of many brilliant, timely, and concerned working scientists.

[and then there is feel]

Posted on December 10, 2016 by Snow-Leavis

I need ethics because I am on my own.
I can only see with my own eyes.
I try to shift my stance.
I do not always see what others see

I need ethics because I am ordinary and extraordinary.
I can only see with my own eyes
I try to shift my stance
I do not always see what others see

[and then there is feel]

Reductionism – truly, madly, deeply

Posted on November 24, 2016 by Snow-Leavis

On Friday the 25th of November 2016 I gave a talk for the Scottish Philosophy and Psychiatry Special Interest Group.

My subject was “Improvement Science”.

The following is based on the slides and the four short films that I presented.

My talk was entitled:
001-improvement-science The meeting was held at the Golden Lion Hotel, Stirling:I started the day off:
I gave these declarations:

I explained to the audience that like Dr Rev I M Jolly I can be overly pessimistic:

The dictionary definition of ‘Improvement’:

The dictionary definition of ‘Science’:

My concern is any pre-determinism to science:

The Health Foundation have considered Improvement Science: this is from 2011:

Many different terms are used including “QI” for “Quality Improvement”:

This is where improvement science began, in Boston, Massachusetts:

The Founder of the Institute for Healthcare Improvement (IHI) was Don Berwick:

The first description of this movement in Britain goes back to 1992 by Dr Godlee:

Fifteen years later, Dr Godlee, Editor of the BMJ, said this:
015-improvement-science

Only last month the BMJ briefly interviewed Don Berwick:

IHI describes improvement science as being based on a “simple, effective tool”:

This tool was developed from the work of an American engineer, W. A. Deming:

The “Model for Improvement” Tool [TM] is described by IHI as a “simple, yet powerful tool”:

The current President and CEO of IHI is Derek Feeley:

Up until 2013, Derek Feeley was Chief Executive [Director General] for NHS Scotland:

In April 2013 Derek Feeley resigned from NHS Scotland:

22nd February 2015 it was reported: “The astonishing and largely hidden influence of an American private healthcare giant at the heart of Scotland’s NHS”:

Dr Brian Robson, Executive Clinical Director for Healthcare Improvement Scotland [HIS] is an “IHI Fellow”:

Professor Jason Leitch, National Clinical Director for the Scottish Government is an “IHI Fellow”:
026-improvement-science

Might we be facing the biggest change to healthcare in Scotland since the NHS began?

Improvement science is moving quickly and widely across Scotland:

This “Masterclass 1” for Board members cost £146,837:
028-improvement-science

An NHS Board member commented after the Masterclass:

Healthcare Improvement Scotland is one organisation with a very wide remit over NHS Scotland and it works closely with the Scottish Government:

Nine cohorts of Safety Fellows and National Improvers have so far been trained following IHI methodology:
032-improvement-science

I was reminded of the current enthusiasm for improvement science when the Convener of a recent Scottish Parliament Committee meeting said of targets (another approach enthusiastically taken by NHS Scotland):

What is the place of ethics in Improvement Science?

In 2007 the Hastings Centre, USA, looked into this in some depth:

The Hastings Centre argue that Improvement science cannot ignore ethics:
036-improvement-science

In 2011 the Health Foundation, UK, produced this “Evidence Scan”:

The Health Foundation commented that “improvement science is just emerging”:

The Evidence Scan found a “real paucity of evidence about the field of improvement science”:

I would also suggest that there is a real paucity of philosophy about the field of improvement science:

The Health Foundation did find papers on the conceptual nature of Improvement Science but concluded that:

Mary Midgley is a philosopher now aged 95 years who is widely respected for her ethical considerations:

Chapter 7 of her book “Heart and Mind: The Varieties of Moral Experience” begins:

Mary Midgley is concerned about the overuse of reductionist tests in medicine stating that:

This film is about the potential consequences of inappropriate reductionism:

Leon Eisenberg has written many papers about this subject. He argues that reductionism should not be “abandoned” but that we must keep sight of where such an approach is scientifically useful and also where it is inappropriate:

In the Hastings Report, Margaret O’Kane asks:

In my view the answer to this question is YES. I am hopeful that the National Improvers recruited to NHS Scotland would agree:

As an NHS doctor I have seen unintentional harm brought about by National improvement work in Scotland. This related to a “Screening Tool” that was introduced across Scotland as part of this work. I found that the unintended consequences of the use of the following tool included implications for patients’ autonomy and the risk of over treatment:
048-improvement-science

Both the Hasting Group and the Health Foundation are of the view that improvement science cannot separate itself from the ethical requirements of research:

This article published in February 2016 argues that individual “rights transcend all aspects of Improvement science”

The following is a verbatim representation of a conversation held by National Improvers working in NHS Scotland:

In November 2016 Professor Joshi, also a psychiatrist outlined his concerns about reductionism in a published letter to the BMJ:

In this short film the mechanical language of healthcare improvers is considered:

Professor John Bruce was a Moral Philosopher in Edinburgh University in the 18th century. He built this temple, the “Temple of Decision”, in the grounds of his home by Falkland Palace so that he could consider his thesis:

Professor John Bruce did not succeed in his endeavour. His Temple however stood for many years:

But it eventually collapsed and his endeavour to “reduce the science of morals to the same certainty that attends other sciences” collapsed with it.

Any search of Healthcare Improvement Scotland for “ethics” finds this result:

This film is about more up-to-date buildings – the enthusiasm for which was based on improvement science: The Red Road flats in Glasgow:

                         Post-script:

The following is an edited clip of the evidence given to the Scottish Parliament by Healthcare Improvement Scotland (HIS) on the 31st January 2017:

The full session can be watched here

The Official Report can be accessed here

A fortunate man

Posted on November 20, 2016 by Snow-Leavis

The Body Lift

Posted on November 11, 2016 by Snow-Leavis

This is a more experimental film and is based on attending a Conference by Aberdeen Council on the 27th October 2016 in the old Anatomy Department of Marischal College.

The Conference was on “customer experience” and was extremely well put together. This meeting truly realised the benefits of shared learning and wider thinking. I felt very lucky to be a part of it.

I gave a brief 5 minute talk on “bedside manner” in the old dissecting room where 28 years ago I had learned anatomy.

One of the talks I most benefited from was by the philosopher Dr Bob Plant. His talk made me think of divides – the dissections of understandings. The film ends with dissections on the body of “Caledonian Antisyzygy”.

This film begins with my friend Dr Flaxman going up in the old lift to the Town House Archives. We had just left another lift behind, the lift in the Anatomy Department where bodies were brought up to the “Drain”. That is why I have called this film “The Body Lift”